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New QME study Flashcards

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1
Q

What is the maximum time a QME has to offer an evaluation appointment after initial contact?

A

60 calendar days (90 days if in Extended Service Area) - CCR §36(a)

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2
Q

Which form must a QME file within 5 business days of setting an appointment?

A

QME Form 112 - Appointment Notification Form - CCR §36(b)

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3
Q

How many times can a QME reschedule an evaluation under CCR §36?

A

Only once, and all parties must be notified in writing - CCR §36(d)

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4
Q

Who arranges the interpreter for a QME evaluation if needed?

A

The party who schedules the appointment - CCR §36(g)

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5
Q

Can an evaluation be audio or video recorded by default?

A

No, it requires mutual written consent of all parties - CCR §36(h)

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6
Q

What does CCR §36.5 govern?

A

Scheduling timelines specifically for psychiatric or psychological QME evaluations

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7
Q

What is the deadline to schedule a psychiatric QME evaluation?

A

Within 60 days of the date the appointment is first offered - CCR §36.5(a)

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8
Q

What happens if the psychiatric QME’s next available date is more than 60 days away?

A

The party may request a QME replacement under CCR §31.5(a)(12) - CCR §36.5(b)

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9
Q

What is the scheduling window in Extended Service Areas for psychiatric evaluations?

A

90 days - CCR §36.5(c)

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10
Q

By when must a QME serve the initial comprehensive med-legal report?

A

Within 30 calendar days of the evaluation - CCR §38(a)

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11
Q

What allows a 15-day automatic extension for a QME report?

A

Receiving records less than 15 days before the exam - CCR §38(c)

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12
Q

How many extensions may a QME request for a report and what must be shown?

A

One 30-day extension showing good cause, requested before the deadline - CCR §38(d)

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13
Q

What are examples of good cause for an extension under CCR §38(d)?

A

Family emergency, delayed test results, missing records, patient no-show

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14
Q

What is the deadline to serve a supplemental QME report?

A

Within 60 days of the request unless the parties agree otherwise - CCR §38(h)

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15
Q

What happens if a QME fails to serve a report on time without an extension?

A

The report may be excluded, and a new panel can be requested - CCR §38(e)

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16
Q

Which form must be filed to declare that a QME report was served?

A

QME Form 122 - Declaration of Service - CCR §39(c)

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17
Q

Which form must be filed to confirm the accuracy of a med-legal report?

A

QME Form 123 - Declaration of Medical Evaluator - CCR §39(d)

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18
Q

What is QME Form 111 used for?

A

Requesting a QME panel for an unrepresented injured worker - CCR §31.1

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19
Q

What is QME Form 113 used for?

A

Declaring QME unavailability due to vacation, illness, etc. - CCR §36(a), §36(d)

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20
Q

Is there an official DWC form to request an extension of the QME report deadline?

A

No — the QME must submit a written letter served on all parties before the deadline - CCR §38(d)

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21
Q

Q

A

A

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22
Q

What form must be attached to every QME report to certify it was completed in accordance with DWC rules?

A

QME Form 123 – Declaration of Accuracy

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23
Q

What form is used to show that parties were served a copy of the QME report in unrepresented cases?

A

QME Form 122 – Proof of Service by Mail

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24
Q

When is QME Form 110 submitted?

A

Before the evaluation, to notify parties of the evaluation appointment.

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25
Is QME Form 110 submitted with the completed report?
No, but it becomes part of the case file and must be submitted separately before the evaluation.
26
What form is required to certify interpreter use in a QME exam?
There is no separate form; interpreter details must be documented in the body or addendum of the QME report.
27
What interpreter information must be documented in the QME report?
Name, language, certification status, and a statement that they were present.
28
In unrepresented cases, what additional form must accompany the QME report?
QME Form 122 – Proof of Service by Mail
29
What regulation requires a QME to attach the Declaration of Accuracy to the report?
Title 8 CCR §39(d)
30
What must a QME include in a report when an interpreter is used during the evaluation?
A statement that an interpreter was used, including their name and language spoken.
31
Is a Proof of Service form required in represented cases?
No, QME Form 122 is only required in unrepresented cases.
32
What form confirms all parties were notified of the QME appointment date and time?
QME Form 110 – QME Appointment Notification Form
33
Is a Medical-Legal Report Checklist a required form for QME reports?
No, but it is recommended to ensure all required elements under CCR §49 are included.
34
What must be documented in a QME report involving psychiatric evaluation?
Compliance with CCR §36.5, including discussion of causation, pre-employment history, and substantial medical evidence.
35
When submitting a supplemental QME report, what form must be included?
No additional form is required; the report must reference the original and clearly state it is a supplemental.
36
What should be included with a QME report packet for submission?
The completed report, Form 123 (Declaration of Accuracy), Form 122 (if unrepresented), interpreter documentation (if used), and supporting records.
37
What is the purpose of QME Form 123?
To affirm that the QME report is complete and in compliance with DWC regulations.
38
Who receives copies of the completed QME report and attachments?
All parties to the case, including the injured worker, claims administrator, and attorneys (if any).
39
What regulation governs the completeness of QME reports?
Title 8 CCR §49
40
Can an AME use the same forms as a QME for report submission?
Yes, but the report must indicate it is from an Agreed Medical Evaluator and be signed by both parties.
41
What is the risk of submitting a QME report without Form 123?
The report may be considered incomplete and inadmissible until corrected.
42
Q
A
43
What form must be attached to every QME report to certify it was completed in accordance with DWC rules?
QME Form 123 – Declaration of Accuracy
44
What form is used to show that parties were served a copy of the QME report in unrepresented cases?
QME Form 122 – Proof of Service by Mail
45
When is QME Form 110 submitted?
Before the evaluation, to notify parties of the evaluation appointment.
46
Is QME Form 110 submitted with the completed report?
No, but it becomes part of the case file and must be submitted separately before the evaluation.
47
What form is required to certify interpreter use in a QME exam?
There is no separate form; interpreter details must be documented in the body or addendum of the QME report.
48
What interpreter information must be documented in the QME report?
Name, language, certification status, and a statement that they were present.
49
In unrepresented cases, what additional form must accompany the QME report?
QME Form 122 – Proof of Service by Mail
50
What regulation requires a QME to attach the Declaration of Accuracy to the report?
Title 8 CCR §39(d)
51
What must a QME include in a report when an interpreter is used during the evaluation?
A statement that an interpreter was used, including their name and language spoken.
52
Is a Proof of Service form required in represented cases?
No, QME Form 122 is only required in unrepresented cases.
53
What form confirms all parties were notified of the QME appointment date and time?
QME Form 110 – QME Appointment Notification Form
54
Is a Medical-Legal Report Checklist a required form for QME reports?
No, but it is recommended to ensure all required elements under CCR §49 are included.
55
What must be documented in a QME report involving psychiatric evaluation?
Compliance with CCR §36.5, including discussion of causation, pre-employment history, and substantial medical evidence.
56
When submitting a supplemental QME report, what form must be included?
No additional form is required; the report must reference the original and clearly state it is a supplemental.
57
What should be included with a QME report packet for submission?
The completed report, Form 123 (Declaration of Accuracy), Form 122 (if unrepresented), interpreter documentation (if used), and supporting records.
58
What is the purpose of QME Form 123?
To affirm that the QME report is complete and in compliance with DWC regulations.
59
Who receives copies of the completed QME report and attachments?
All parties to the case, including the injured worker, claims administrator, and attorneys (if any).
60
What regulation governs the completeness of QME reports?
Title 8 CCR §49
61
Can an AME use the same forms as a QME for report submission?
Yes, but the report must indicate it is from an Agreed Medical Evaluator and be signed by both parties.
62
What is the risk of submitting a QME report without Form 123?
The report may be considered incomplete and inadmissible until corrected.
63
What is the purpose of DEU Form 101?
To request a Summary Rating Determination of the QME’s report in unrepresented cases.
64
Who completes and submits DEU Form 101?
The claims administrator or the unrepresented injured worker.
65
When is DEU Form 101 used in the QME process?
After the QME evaluation is completed, to obtain a permanent disability rating from the DEU.
66
Is DEU Form 101 submitted by the QME?
No, it is submitted by the claims administrator or injured worker.
67
What must be submitted with DEU Form 101 in unrepresented cases?
The QME report and QME Form 122 (Proof of Service by Mail).
68
What form must accompany Form 101 if submitted by the injured worker?
Form 100 – Employee's Request for Summary Rating Determination.
69
What is the purpose of DEU Form 100?
It is the Employee’s Request for Summary Rating Determination, submitted when an unrepresented worker wants the DEU to rate a QME report.
70
Who completes DEU Form 100?
The unrepresented injured worker.
71
When must DEU Form 100 be submitted?
When the injured worker is requesting a summary rating based on a QME report in an unrepresented case.
72
What does DEU Form 102 do?
It is the Employer’s Request for Summary Rating Determination of a QME’s report.
73
Who uses DEU Form 102?
The claims administrator or employer, to request a summary rating from the DEU.
74
In what type of case are DEU Forms 100 and 102 used?
In unrepresented cases where a summary rating of the QME’s report is needed from the DEU.
75
What is QME Form 111 used for?
To notify the DWC Medical Unit of a QME’s unavailability for scheduling evaluations for a specific period.
76
What must be included in QME Form 111?
Dates of unavailability and the reason, such as vacation or medical leave.
77
What is QME Form 113 used for?
To notify the DWC of a change in a QME’s address or practice location.
78
Under what regulation must a QME file Form 111 for unavailability?
Title 8 CCR §33
79
Under what regulation must a QME report changes to contact information or practice location?
Title 8 CCR §34
80
What does Title 8 CCR §36 cover?
Procedures for scheduling QME evaluations and issuing QME reports in unrepresented cases.
81
What does Title 8 CCR §38 outline?
Rules regarding time frames and rescheduling of QME evaluations.
82
What does Title 8 CCR §39(d) require for QME reports?
Attachment of a Declaration of Accuracy (Form 123) to every QME report.
83
What is the purpose of Title 8 CCR §49?
It lists the required elements that must be included in a complete medical-legal report.

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